‘autism’

When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.

We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.

When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…

Signs of Autism In Infants & Toddlers:

There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,

You should observe your infant demonstrating curiosity.

You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.

Your child should show you they know their name by 1 year of age.

You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.

However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »

Many parents worry about their child’s development at one point in time. With each of my boys, I had worries about their communication and thought their language delays or behaviors signaled something serious. That might just be the “worrier” in me, but it might just be the “mom” in me, too. Competitive parenting makes us all a little nuts…

Here’s a few signs that your child is developing great communication skills on time. However, if at any time you worry that your child isn’t expressing joy, communicating thoughts, or reflecting an understanding of your language, visual cues, and behavior talk with your child’s doctor. If you don’t feel heard or continue to worry, schedule another visit. If you still worry, contact another doctor for a second opinion. Instincts serve us very well when it comes to parenthood. Further, find some peace of mind if your child is doing many of the behaviors listed below!

Reassuring Developmental Milestones For Infants & Children

Responds to her name between 9-12 months of age.

Smiles by 2 months, laughs and giggle around 4-5 months, expresses great joy to your humor around 6 months.

Plays and thinks peek-a-boo is funny around 9 months of age.

Makes eye contact with people during infancy.

Tries to say words you say between 12 and 18 months of age.

Your toddler uses 5 words by 18 months of age.

Copies your gestures like pointing, clapping, or waving.

Imitates you — ie pretends to stir a bowl of pancake mix when you give them a spoon and bowl or pretends to talk on the phone with a play cell phone.

Shakes head “no.”

Waves “bye-bye” by 15 months of age.

Points to show you something interesting or points to get your attention by 18 months of age.

A recently published study proposed and evaluated a new autism screening checklist for the 1-year well baby check-up. I had a hard time getting my hands on the study (crazy but true–even pediatricians sometimes are boxed out of research studies), but read lots about it first in the press. I was excited about the potential for early screening. The checklist, designed to be administered by a pediatrician, intends to improve early detection and diagnosis of autism. The goal: to enable early intervention and treatment for at-risk children. It’s clear that early intervention improves autistic children’s outcome with autism spectrum disorders but the media may have provided false information and false hope. So before you expect this checklist at your baby’s next 1-year check up, let me explain what the study found, my concerns about the results, and how the checklist may become useful.

I take care in using any screening tool–any intervention can cause unnecessary harm. My main concern resides around false positives (when a test suggests there is a problem when in reality there isn’t) and the numbers from this study… Read full post »

Tomorrow I have the privilege to give opening remarks and introduce Alison Singer. Ms Singer is the founder and president of the Autism Science Foundation. She’ll speak about advances in autism research in honor of National Infant Immunization Week. Ms Singer has a daughter with autism as well as a brother with autism and has worked for both Austism Speaks and with the Interagency Autism Coordinating Committee to provide leadership on strategic goals for autism research at the national level. She’ll speak about her belief that immunizations do not cause autism while highlighting goals for ongoing research and education efforts to support families with autism. Everyone is welcome; please join us! Read full post »

Dr Ari Brown, a pediatrician and author (books in photo), was on Dr Oz yesterday. She was asked to join a discussion about autism. Dr Brown is a board-certified developmental pediatrician, a mom to two, and an advocate for science. She is passionate and clear about what she believes. She is speaking all over the country about how to protect children from illness, particularly when making decisions about vaccines. She contributed ideas in my series in late 2010 entitled, “Do You Believe in Vaccines: part I, part II, and part III.” On Dr Oz, she was asked to contribute to a discussion about autism that ultimately focused on fears about vaccines. I worry the discussion wasn’t a representation of most American families and even Autism Speaks refused to join the show.

She’s shared with me a blog post she wrote after being on the show. Many other pediatricians are writing about the show; read Dr Natasha Burgert’s post, too. On the show, Dr Brown sat next to Dr Bob Sears, a pediatrician who deviates from the recommended AAP schedule and had a chance to discuss her take. She sheds light on what we can do as parents to really understand. Thanks, Dr Brown.

I am thankful, Dr Oz, for the opportunity to participate in your autism show. Both the American Academy of Pediatrics and I hoped the show would help educate the public and move the conversation forward.
As a pediatrician who talks with families everyday in my office, I know parents want to know more about both vaccine safety and about autism. I’m also a mom. Like you, I need accurate information to protect my kids as best as I can.
I am concerned that viewers took away a very inaccurate view of vaccines. The most vocal audience members represent a small minority. Most parents of children with autism agree with the scientific evidence and do not believe that vaccines cause autism. Read full post »

Yesterday, results of a survey on beliefs about vaccines circulated on the internet. The survey conducted last week, asked over 2000 adults if they believed vaccines, or the MMR shot, caused autism. I’m not an expert on surveys and I don’t know how reproducible these results are to all parents in the US. But the news caught my eye (along with many others) when they reported: “Just a slim majority of Americans — 52 percent — think vaccines don’t cause autism” That’s a kind-of-odd-double-negative-type way to look at it, I suppose. Or maybe a hopeful one. The results reflect that nearly half of adults in America may suspect or worry that vaccines cause autism; 18% saying they believe a connection exists.

Whew.

The survey reminds us of some of the Why. It seems on some level, it’s a breakdown in our education. While only “69 percent of respondents said they had heard about the autism-vaccination theory — only half (47 percent) knew that the original Lancet study [that linked vaccines and autism] had been retracted, and that some of that research is now alleged to be fraudulent.” And, the details of all the research finding no link between autism and MMR is even more deeply buried, I suspect.

Even so, the numbers surprised me. In light of all the writing in the British Medical Journal this month on the scam behind Andrew Wakefield’s original paper in 1998 making the claim, I’ve been thinking about where we all stand in our understanding of immunizations, science, and trust. More on that next week. But I really wouldn’t have said 1/2 of my patient’s parents believed or suspected in a connection between autism and vaccines. What percentage would you have guessed? Read full post »

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

When the exam room door closes, most parents have some questions about how their child is developing or behaving. Competitive parenting abounds; everyone wants to prove or believe his or her child is above average. The he-did-what?-she’s-so-smart stories can strike fear in your heart when your child is nowhere near the same accomplishment and of similar age. These comparisons can sometimes lead to worry. A lightning bolt drove through my chest when my mom started to compare F to other children and expressed worry that he might never say, “Mama.” I waited impatiently and in unified worry until about 18 ½ months.

Even the mamas and papas who seem to brag at the supermarket, on the phone, or at book club about how much their child talks-walks-sleeps-eats worry. I mean it; they worry, too. Don’t let ‘em fool you. Worry may be just below sleep deprivation on the job description for parenthood. Being a pediatrician has proven this to me.

If you worry about what or how your child is doing, speak up. Let your pediatrician know. Don’t be intimidated by the length of the appointment, the reason for your worry (Joey is eating toe jam) or even if you’ve asked before. If you’ve previously discussed a problem, revisit your concern if worry remains in your heart. Your instincts matter. Read full post »

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Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.